Ky. Law Focuses On Youngsters' Eyesight

A Kentucky law that requires children to undergo eye exams before
they start school helped 7-year-old Dakota Jenkins get the glasses he
needed to correct his farsightedness before he entered kindergarten two
years ago.

The state mandate wasn't in place for Dakota's 13-year-old sister,
Debra, when she started school in Shelby County, Ky., with an
undetected case of amblyopia, or lazy eye. By the time an optometrist
diagnosed the problem at the end of her 4th grade year, Debra was
nearly blind in her left eye and had to wear thick glasses and an eye
patch.

"Trying to get a 4th grader to wear an eye patch is an absolute
nightmare," Debra's mother, Dana Jenkins, said last week. "If we'd
caught it at age 5, our doctor would have had more time to correct
it."

Passed in 2000 as part of a comprehensive bill on children's health
care, the Kentucky eye-exam requirement is the first and only law of
its kind in the United States.

In other states, the responsibility for spotting vision problems in
children falls to pediatricians, primary-care physicians, and school
nurses, who typically rely on simple vision screenings that test
distance vision. The American Academy of Pediatrics recommends that all
preschool children receive such screening by age 4.

But many optometrists and ophthalmologists argue that children need
a closer look—by a trained eye. The American Optometric
Association recommends children receive their first comprehensive eye
examinations by medical professionals at 6 months of age.

"In the typical vision screening, if a child can read a chart from
20 feet, they're considered to have healthy eyes," said Dr. Joel N.
Zaba, an optometrist. "That sounds great, but the children in our
classrooms don't read books and do schoolwork from 20 feet away."

In short, "sight screening doesn't take the place of a comprehensive
eye exam," Dr. Zaba said.

Beyond Screening

To underscore the importance of eye exams, Dr. Zaba, a Virginia
Beach, Va., optometrist who has written about the social and emotional
problems children suffer when vision problems go untreated, points to a
recent study he led of the Kentucky program.

The report found that one in seven children examined as part of that
initiative needed glasses.

Published in the March issue of Optometry: Journal of the
American Optometric Association, the study was based on a sample of
5,316 children examined by eye doctors between July 15, 2000, and April
1, 2001. About 50,000 children enter kindergarten in Kentucky each
year.

The more alarming finding, the report's authors say, was the
discovery that nearly 4 percent of the children were diagnosed with the
potentially sight-stealing lazy eye, and just over 2 percent had
strabismus, more commonly known as crossed eyes.

"It's critical that we are able to identify and correct [lazy eye]
at an early age," said Dr. William T. Reynolds, a Richmond, Ky.,
optometrist who was a co-author the study. "Children with this
condition can suffer a 50 percent reduction in their vision after the
age of 5. The longer it's ignored, the harder it is to correct."

The exams performed by Dr. Reynolds and other practitioners across
the state went beyond screening for nearsightedness to test whether a
child's eyes can track lines of text across a page or a computer
screen, the ability of both eyes to work together properly, and their
ability to focus on objects that are 16 to 18 inches away.

The authors of the Kentucky study say there are signs that laws
supporting comprehensive vision testing might become more common.
Similar legislation has been introduced in New York state and is under
consideration in Arkansas, Georgia, Nebraska, and New Hampshire, Dr.
Reynolds said.

Federal legislation that would help states pay for children's eye
exams is expected to be introduced this spring in the House and the
Senate, he added.

"As far as anything immediate, though, that seems unlikely with the
economy the way it is," he said. "Still, if we can come up with a
long-term study at some point that shows the cost-benefit of this
program, that will help."

Follow-up Rare

A number of studies published by pediatric and ophthalmic journals
show that as many as 60 percent of children don't receive even the
routine eye screenings recommended by the American Academy of
Pediatrics, according to data provided by the Vision Council of
America, based in Washington.

Of the minority who do receive screenings, the nonprofit trade group
reports, 90 percent are given clean bills of health, only to have later
exams by licensed eye doctors reveal vision problems in 10 percent of
those children.

And because vision screenings are rarely preformed by doctors, the
council estimates that half of all children identified with a vision
problem don't receive the treatment they need.

Those numbers don't surprise Steven R. Edelman, a psychologist with
the 50,700-student Cumberland County school system in Fayetteville,
N.C., who helps test special education students for vision
problems.

Mr. Edelman recently shared the school health records of a dozen
elementary students (with identifying information omitted) who attend a
low-performing school that serves primarily black students from
low-income families. In every case, school health officials had failed
to test near vision, even when a child was diagnosed with attention
deficit hyperactivity disorder or labeled "developmentally
delayed."

And in cases where vision problems were discovered, persistent
follow-up was rare, and the children typically went untreated.

The fact that students aren't screened for vision problems until
they're 8 years old "was very odd to me, since they started to learn to
read and write well before that," the psychologist said. "I wonder how
many young children who were identified as reading-disabled really had
problems with vision."

Vol. 22, Issue 33, Pages 25, 28

Published in Print: April 30, 2003, as Ky. Law Focuses On Youngsters' Eyesight

See also an interactive map
detailing state legislation on child vision screenings.

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